Ovarian Cancer: Surgery

Surgery is a common part of ovarian cancer treatment. It's used to take out as much of the cancer as possible. There are many different types of surgery.

It's best for women with ovarian cancer to be treated by a gynecologic oncologist. This is a doctor who specializes and is an expert in the diagnosis and treatment of gynecologic cancers. These include ovarian cancer. Surgery is often needed for an accurate diagnosis and proper staging of the disease. The type of surgery you have depends on these factors: 

• The type of ovarian cancer you have

• Whether the cancer is just in your ovary or has spread

• If you plan to become pregnant in the future

• Your general health

• Your age

In some cases, if the cancer was found at an early stage and hasn’t spread, your surgeon may be able to leave your uterus and one ovary and fallopian tube intact. This is called fertility-sparing surgery. Then you may be able to get pregnant in the future. If you have both of your ovaries, fallopian tubes, and uterus removed, you will no longer become pregnant. This surgery is called a bilateral salpingo-oophorectomy. You’ll enter sudden menopause, if you have not already reached it. That means you will no longer have menstrual periods. You may have symptoms like hot flashes soon after surgery. 

You may have more than one type of surgery. These may be done as part of the same procedures or as separate procedures. Depending on the type and stage of your cancer, you may or may not have another type of treatment. These may include chemotherapy, which may be done before or after surgery.

No matter what type of surgery you have, it’s important for the cancer to be surgically staged. This is done to tell the extent of the disease. To do this, a healthcare provider checks tissue samples (biopsies) that have been removed during surgery. Your surgeon may also remove one or more lymph nodes. This is called a lymph node biopsy. Your healthcare provider checks these samples to see if they have cancer cells.

Types of surgery used to treat ovarian cancer

Total hysterectomy with bilateral salpingo-oophorectomy

This surgery is the one most commonly done for ovarian cancer. The following will be removed:

• Both of your ovaries

• Both of your fallopian tubes

• Your uterus

• Your cervix. This is the narrow end of the uterus that connects it to your vagina.

Your surgeon may also remove your omentum. This is a fatty apron of tissue in front of your belly. It’s attached to your large bowel. It’s a common site of spread for ovarian cancer. This may be called an omentectomy.

Oophorectomy

In an oophorectomy, your surgeon takes out one or both of your ovaries. This depends on the likelihood that the cancer will spread. It may also depend on if you want to become pregnant in the future. If the cancer has not spread to more than one ovary, your surgeon may only take out one ovary and one fallopian tube. This is called salpingo-oophorectomy. This would allow you to get pregnant in the future. Removing both ovaries and both fallopian tubes is called a bilateral salpingo-oophorectomy.

Lymph node biopsy

Your healthcare provider may remove one or more lymph nodes at the same time as a salpingo-oophorectomy. This may be done with or without a hysterectomy. These small glands are part of your immune system. They help your body fight infections. Cancer often spreads to them. Your surgeon removes nodes close to the ovaries. He or she checks them right away for signs of cancer.

Cytoreduction

During this surgery, your surgeon removes as much of the cancer as possible. This is also called debulking. Your healthcare provider may suggest this surgery when the cancer has spread throughout your abdomen.

If you have this surgery and cancer has spread to your colon, you may need to have part of your colon removed as well. Most of the time, your colon can be reattached during this surgery. But you may need a colostomy. A colostomy means that the surgeon diverts a piece of your bowel through your abdomen. This lets the remaining intestines to heal. Your stool will then drain into a pouch that sticks on the skin of your abdomen. This is often temporary. Later on, it may be reversed by another surgery.  

You may also need other organs partially or fully removed during a cytoreduction. These can include your small intestine, appendix, stomach, spleen, bladder, liver, or ureter.

Debulking can also be done after chemotherapy. This is called neoadjuvant chemotherapy. Most people have cytoreductive surgery done first. This is to remove as much of the tumor as possible. Then, chemotherapy is given. But some people, especially those with extensive disease, seniors, and those with many health issues, may need another treatment approach. This may include surgery to remove as much of the cancer as possible. Then they’ll get chemotherapy later.

Risks of ovarian cancer surgery

All surgery has risks. The risks of ovarian cancer surgery include:

• Heavy bleeding

• Infection

• Damage to internal organs

• Bulging of organs under the incision (incision hernia)

• Air in the chest cavity (pneumothorax)

• Blood clots

Your risks depend on your overall health, what type of surgery you need, and other factors. Talk with your healthcare provider about which risks apply most to you.

Getting ready for surgery

Your healthcare team will talk with you about the surgery options that are best for you. You may want to bring a family member or close friend with you to checkups. Write down questions you want to ask about surgery. Make sure to ask the following:

• What type of surgery you’ll have

• What will be done during surgery and which organs will be removed (Will there be changes in how your body works?)

• The risks and side effects of the surgery

• If you’ll be able to get pregnant after surgery

• If you’ll go into menopause after surgery

• When you can return to your normal activities

• If the surgery will leave scars and what they will look like

Before surgery, tell your healthcare team if you’re taking any medicines. This includes over-the-counter medicines, vitamins, herbs, and other supplements. This is to make sure you’re not taking medicines that could affect the surgery. After you’ve talked about all the details with the surgeon, you’ll sign a consent form that says that the healthcare provider can do the surgery.

You’ll also meet the anesthesiologist. You can ask questions about the anesthesia and how it will affect you. Just before your surgery, an anesthesiologist or a nurse anesthetist will give you medicine called anesthesia. This is so that you fall asleep and don’t feel pain.

After your surgery

You may have to stay in the hospital for a few days. This depends on the type of surgery you had. For the first few days after surgery, you’re likely to have pain from the incision. Your pain can be controlled with medicine. Talk with your healthcare provider or nurse about your options for pain relief. Some people don’t want to take pain medicine, but doing so can help your healing. If you don’t control pain well, for instance, you may not want to get out of bed, cough, or turn over often. You need to do these things as you recover from surgery.

You’ll likely have a urinary catheter for a few days. This a tube put through your urethra and into your bladder so that your urine goes into a bag outside your body. In some cases, you may go home with the catheter still in.

You may have trouble moving your bowels. Talk with your healthcare provider, nurse, or a dietitian about what you can eat to reduce the chance of constipation. It can be caused by some pain medicines, from not moving much, or from not eating much. Talk with your healthcare provider or nurse about getting more dietary fiber or using a stool softener.

You may feel tired or weak for a while. The amount of time it takes to recover from surgery is different for each person.

Recovering at home

When you get home, you may get back to light activity. But you should avoid strenuous activity for at least six weeks. Your healthcare team will tell you what kinds of activities are safe for you while you recover. They will also talk to you about problems you should watch for and report to them. They’ll also let you know how to take care of the incision.

Follow-up care

Your healthcare team will tell you when to see your surgeon again for a checkup and maybe to have sutures or staples removed.

You may need chemotherapy after surgery. Your healthcare provider will talk with you about this type of treatment. It's usually not started until your body has had time to heal from the surgery.

When to call your healthcare provider

Let your healthcare provider know right away if you have any problems after surgery. These can include the following:

• Bleeding

• Redness, swelling, or fluid leaking from the incision

• Fever

• Chills

 Ask who you should call and what number you should use. Be sure you know how to get help anytime, including after office hours and on weekends and holidays.